I. Concept
Syphilis is a common sexually transmitted disease that occurs when the human body is infected by syphilis spirochetes, which is currently distributed worldwide and is a very important sexually transmitted disease; it can be divided into acquired syphilis, congenital syphilis and gestational syphilis, etc.
Second, the transmission route of syphilis
There are three different ways of syphilis transmission.
1, direct sexual contact infection syphilis: 95% to 98% of syphilis is infected through sexual contact. Patients who are infected without treatment are highly contagious within 1 to 2 years, and the contagiousness gradually decreases with the prolongation of the disease period. Kissing, homosexuality, oral-genital contact, hand-genital contact and other acts can also transmit syphilis, damage can occur in the mouth and lips, anus, tongue, throat, fingers and other parts.
2, indirect contact syphilis: syphilis can be transmitted through indirect contact, the infection is contact with the patient’s used underwear, underwear, bedding, towels, razors, bath towels, bath tubs, commode, etc., as these utensils may be contaminated with syphilis spirochetes discharged from the patient’s damage. Thus, infection can occur.
3, blood-borne syphilis: Some people can transmit syphilis through blood transfusion. If the blood donor is a latent syphilis patient, the blood he or she provides may have syphilis spirochetes in it. Once input into the recipient’s body, the infection can be produced, such patients do not produce the performance of stage one syphilis, but directly appear the symptoms of stage two syphilis. Therefore. It is very important to conduct serological screening tests for syphilis in blood donors.
III. Clinical manifestations
(I) Incubation period
The incubation period of syphilis is about 9 to 90 days, when the patient is infected with syphilis, the clinical serologic reaction is positive at this time, and the symptoms are temporarily receding.
(ii) Stage I syphilis
Occurs 3 weeks after infection. A hard, painless, round nodule appears at the site of infection. The nodule starts to be flushed and moist, and gradually breaks down and erodes, forming an ulcer, which is the stage I syphilis hard chancre. In men, it occurs on the foreskin, coronal sulcus, glans or tethered area of the penis. In homosexual men, it is often found in the anorectal area. In women, it often occurs in the inner part of the labia majora and minora, and may also occur in the cervix and other areas. The lymph nodes in the groin are also enlarged bilaterally, but are not painful. The chancre can occur on the lips, jaw and tongue, as well as on the eyelids, fingers and breasts in cases where the chancre does not heal. The hard chancre of stage I syphilis contains many syphilis spirochetes and is often accompanied by swollen local lymph nodes, which are highly contagious. The chancre lasts for 2-6 weeks and then resolves on its own without leaving a scar. However, because the site of the chancre in women is hidden and asymptomatic, it is often overlooked and increases the chance of transmission. If stage I syphilis is not treated or improperly treated, the spirochete will spread throughout the body via bloodstream and lymph nodes, and will develop into stage II syphilis in a few weeks.
(C) Stage II syphilis
In patients with untreated syphilis, stage II syphilis usually occurs 6 weeks to 6 months after infection. The syphilis spirochetes in the hard chancre of stage I syphilis are spread throughout the body through the blood circulation after reaching the lymph nodes via the lymphatic vessels. In the early stage, there may be fever, fatigue, headache, sore throat, muscle pain, joint pain, anorexia and other systemic symptoms. More than half of the patients have generalized lymph node enlargement, and occasionally liver and spleen enlargement. The blood picture may have leukocytosis, anemia and elevated blood sedimentation. The hair loss is usually self-healing. Stage II syphilis can sometimes threaten the nervous system, bones, or eyes. If left untreated, the disease can often recur within 1-2 years, when it is highly contagious, or it can naturally improve to latent syphilis. About 70% of patients have a skin rash called syphilis rash. Syphilis rash can have a variety of different manifestations, generally symmetrical and widespread distribution, no itching.
1, spotted syphilis rash: This is the initial appearance of syphilis rash, red, brown or pigmented rose rash, mostly in the trunk to begin with. Later, it develops to the extremities, palms and soles of the feet. The erythema is round and basically symmetrical on the palms of the hands and soles of the feet. This is the reason why syphilis is commonly known as “prune sores”.
2, papular syphilis rash: This is due to the development of the disease, some spots can thicken into papules. It occurs on the trunk, buttocks, calves, palms, soles and face. This is the first time I’ve ever seen this.
3, flat eczema: this is occurring in the external genital area, around the anus and other skin folds and moist parts of the papule. The damage is smooth, thick, flat, flat, the surface is covered with gray film, containing a large number of syphilis spirochetes. The flat warts are more contagious than other second stage syphilis rashes.
4, about 30% of patients have oral mucous membrane damage, called mucous membrane spot. The surface of the damage is covered with gray film, containing a large number of syphilis spirochetes.
(iv) Stage III syphilis
Appears more than two years after infection. There are mainly the following.
1. Late stage benign syphilis. The basic damage is a dendritic swelling, probably due to an inflammatory response to syphilis spirochete antigens, and its pathogenesis is still poorly understood. Microscopically, the active damage is a granulomatous lesion and the old damage is extensive fibrosis. Syphilis spirochetes are generally not found within the dendritic swelling. This inflammatory disease can invade any organ, but most commonly invades the skin and bones. Skin lesions manifest as dermal or subcutaneous nodules, ulcerative nodules and dendritic swellings. The nodules often occur on the face, trunk, and extremities, are asymmetrically distributed in clusters, are painless, and progress slowly with gradual ulceration. The ulcers usually heal slowly from the center, leaving a scar. Cutaneous dendritic swellings are single hard nodules that gradually increase in size to form infiltrative masses and collapse to form ulcers, with some areas of the disease healing spontaneously leaving scar formation. If the oral mucosa and nasal mucosa are involved, it can lead to perforation of the nasal septum and the soft and hard palate, and skeletal damage mainly includes osteochondritis, bone dendritic swelling, etc.
2. Cardiovascular syphilis. There may be aortitis, aortic valve atresia, aortic aneurysm, etc.
3, neurosyphilis. May have spinal consumption, paralytic dementia, optic nerve atrophy, etc.
4, the degree of harm increases, and the rate of disability and death increases.
(E) Congenital syphilis
Congenital syphilis is transmitted from the mother to the fetus through the placenta, often causing premature birth and stillbirth.
1. Early congenital syphilis. The symptoms occur within two years of age. The main manifestations include rhinitis, in addition to pharyngitis, wasting, insomnia, enlarged lymph nodes and liver and spleen, osteochondritis, pseudoparalysis, etc. Skin and mucous membrane damage may include papular scaly or large scarring rash, flat warts, mucosal spots, etc.
2. Late congenital syphilis. Symptoms occur in those who are more than two years old. The manifestations include substantial keratitis, syphilitic teeth, neurogenic deafness, etc. Others are generally similar to stage III acquired syphilis.
IV. Diagnosis of syphilis
Each stage of syphilis has special clinical symptoms and characteristics. If you see chancre with swollen lymph nodes and widespread symmetry all over the body, especially if there is a patchy rash or papule without painful itchy symptoms at the same time in the palm of the hand or foot plantar, or if there is a moist and hyperplastic patchy papule block with generalized swollen lymph nodes in the genital area, the possibility of early syphilis should be considered. If the patient has a history of unclean sexual intercourse, syphilis is more likely.
Laboratory tests should be performed at this time. Laboratory tests include syphilis spirochetes and syphilis serologic reaction tests. The spirochete examination method commonly used in clinical practice is the dark-field light-reflecting method, and the spiral of syphilis spirochetes is tightly regular, refractive, active and easy to identify. The spiral of syphilis is very helpful for the diagnosis of stage I syphilis, especially when the chancre has appeared and the serum syphilis reaction has not turned positive.
It is also easy to find syphilis spirochetes in lesions such as mucosal spots, wet papules and flat warts in stage II syphilis. There are many methods of serological testing for syphilis, and the antigens used are non-spirochete antigens and syphilis spirochete antigens. In the past, crude bovine heart heart mimetic lipid antigen was commonly used for precipitation tests and complement binding tests. Syphilis spirochetes as antigen test, the international commonly used are fluorescent spirochete antibody absorption test, pale spirochete hemagglutination test, etc., its specificity is strong, high sensitivity. The syphilis serologic test is important for the diagnosis of all stages of syphilis, and early syphilis often has a strong positive reaction.
Latent syphilis and asymptomatic neurosyphilis are mainly diagnosed by syphilis serologic test because there are no active clinical symptoms, but it should be noted that syphilis serologic test can show false positive reaction, and some non-syphilis diseases, such as malaria and systemic lupus erythematosus, can show positive reaction, which is called biological false positive reaction. In the early stage of chancre, the syphilis serologic reaction is often negative, and it can also be negative in late syphilis, especially in patients with spinal consumption in late neurosyphilis with a negative rate of up to 30%-50%.
V. Complications
1, mucosal lesions can easily develop into chronic interstitial linguitis, which is a kind of pre-cancerous damage and should be strictly observed.
2, cardiovascular lesions can occur successively simple aortitis, aortic valve closure insufficiency, myocardial infarction, aortic aneurysm or sudden death, etc.
3.Neurosyphilis has a slow onset and can occur as spinal meningitis, which can compress the spinal cord and lead to spasticity and paralysis.
VI. Treatment
Syphilis treatment principles early, adequate, regular medication, penicillin is preferred, after treatment to track and observe, the source of infection and sexual contacts should be examined and treated at the same time.
Treatment drugs
(a) Penicillin is the preferred highly effective anti-syphilis drug, and should last for more than 2 weeks, commonly used are benzathine penicillin, procaine penicillin and aqueous penicillin.
(B) Ceftriaxone sodium has been reported for the treatment of syphilis and has achieved good recent efficacy, but there is no definite experience in the dose, duration and long-term efficacy.
(C) Tetracyclines and erythromycin
The efficacy is worse than that of penicillin, and is usually used as an alternative treatment for penicillin allergic patients. Tetracyclines include tetracycline, doxycycline and minocycline, which are contraindicated in pregnant women and children. Erythromycin is commonly used as erythromycin and azithromycin, and azithromycin should be used with caution for pregnant women.
VII. Cure criteria
(A) Clinical cure
The damage of stage I syphilis (hard chancre), stage II syphilis and stage III syphilis (including skin, mucous membrane, bones, eyes, nose, etc.) is healed and disappears, and the symptoms disappear. However, the following conditions do not affect the judgment of clinical cure: secondary or residual functional disorders (vision loss, etc.); residual scars or tissue defects (saddle nose, dental dysplasia, etc.); syphilis damage heals or subsides, and the syphilis serological reaction is still positive.
(B) Serum cure
Within 2 years after anti-syphilis treatment, the syphilis serological reaction (non-syphilis spirochete antigen test) changes from positive to negative, and the cerebrospinal fluid examination is negative. In the early stage of stage I syphilis (hard chancre), when the serologic reaction is negative, sufficient anti-syphilis treatment has been received and no positive reaction can occur.
Prevention
As for the prevention of other infectious diseases, firstly, we should strengthen health promotion and education, and oppose improper sexual behavior, and secondly, we should take the following preventive measures.
1, track the patient’s sexual partners, including the patient’s self-reported and medical personnel to visit, find all the patient’s sexual contacts, preventive examination, follow-up and necessary treatment, before the cure spouses are absolutely prohibited to have sexual intercourse;
2.Suspected patients should undergo preventive examinations and do syphilis serologic tests for early detection of new patients and timely treatment;
3, syphilis patients found must be forced to isolation treatment;
4, pregnant women suspected of having syphilis should be given preventive treatment in time to prevent syphilis infection to the fetus; unmarried male and female patients, before the cure can not get married;
5. For patients who have received treatment, they should be given regular follow-up treatment.
Nine, the harm of syphilis
1, syphilis spirochete structure mutation, drug resistance. The mutated spirochete is like an upgraded computer operating system, which is more functional, more toxic and less treatable. At the same time, the abuse of clinical antibiotics has accelerated the emergence of drug resistance of spirochetes, making traditional treatment difficult.
2, the degree of harm increased, the rate of disability and death increased. As the toxicity of spirochetes increases after mutation, the degree of damage to body organs increases. Moreover, the rapid development of the disease after mutation, coupled with the poor effect of traditional treatment, has led to an increase in the disability and mortality rate of syphilis. Untreated syphilis will lead to loss of function of organs and even endanger life.
3, syphilis spirochetes invade the central nervous system. It can cause spinal consumption, paralytic dementia, optic nerve atrophy, etc.
4, spirochetes harm the cardiovascular system. It can lead to aortitis, aortic valve atresia, aortic aneurysm, etc.
5, spirochetes damage the skeletal system. Causes tissue and organ destruction, loss of function, leading to disability or death.
6. It leads to psychological diseases. Syphilis is a sexually transmitted disease, long-term illness, the psychological pressure is very high, and over time produce psychological diseases.
7. discomfort symptoms of skin lesions, affecting normal life. The genitalia of syphilis patients will appear ulcers, pustules, rashes and other uncomfortable symptoms, resulting in more secretions, the formation of fear, affecting normal life.
8, the degree of harm to women is greater than men. Women with syphilis not only endanger their own health, but also can be transmitted to the fetus, resulting in premature birth, miscarriage and stillbirth, and a few live births of fetuses are likely to have fetal syphilis.
9, syphilis through sexually transmitted infection syphilis spirochete disease, early invasion of the genitalia and skin, late invasion of all organs of the body, and lead to many serious complications, involving almost all organs of the body, eventually leading to death.
10.Passing to partners or children, endangering the health of others. Syphilis patients not only endanger their own health, and can infect their wives and children, resulting in premature births, miscarriages and stillbirths, and a few live births of fetuses are likely to have fetal syphilis.
11. Loss of sexual function, resulting in disability or death. As the toxicity of the spirochete increases after mutation, the damage to body organs increases, causing tissue and organ destruction and loss of function, leading to disability or death.